Provider Demographics
NPI:1033555859
Name:OPTIMAL CARE PROVIDERS
Entity Type:Organization
Organization Name:OPTIMAL CARE PROVIDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:UZOMA
Authorized Official - Middle Name:BERTRAM
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-270-1255
Mailing Address - Street 1:11111 N HARRELLS FERRY RD
Mailing Address - Street 2:APT: 137
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-8389
Mailing Address - Country:US
Mailing Address - Phone:225-270-1255
Mailing Address - Fax:
Practice Address - Street 1:11111 N HARRELLS FERRY RD
Practice Address - Street 2:APT: 137
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-8389
Practice Address - Country:US
Practice Address - Phone:225-270-1255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD 204952261QH0100X
283X00000X, 310400000X, 313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No283X00000XHospitalsRehabilitation Hospital
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility